Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

Zuo, Lian; Zhan, Yiqiang; Liu, Feifeng; Chen, Chen; Xu, Luran; Calic, Zeljka; Cordato, Dennis; Cappelen‐Smith, Cecilia; Hu, Yunfeng; Li, Gang

doi:10.1002/brb3.1092

Cited by 17 publications

(22 citation statements)

References 28 publications

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“…It might be speculated that women were more prone to develop vascular vertigo, and hence, the male proportion among our vertigo (+) stroke patients was diluted. In line with our findings, previous studies found male proportion of 55%–57% among patients with acute vascular vertigo (Kerber et al, ; Zuo et al, ). In the current work, the infarction volume was insignificantly larger in women.…”

Section: Discussionsupporting

confidence: 93%

“…NIHSS score is lower among patients with vertebrobasilar stroke in comparison to those with stroke in the anterior circulation (Inoa, Aron, Staff, Fortunato, & Sansing, ; Sarraj et al, ; Sato et al, ). This can be explained by the fact that several clinical manifestations related to the posterior circulation like vertigo, nystagmus, nausea, or vomiting are not considered in NIHSS (Zuo et al, ), but may lead to a worse score on mRS or Barthel index. For example, a patient with vertebrobasilar stroke presenting with severe vertigo may have an NIHSS score of 0 but a mRS score of 3, if he requires some help for the activities of daily living.…”

Section: Discussionmentioning

confidence: 99%

“…Affected patients do not usually receive the adequate medical attention and are more likely to consult a general practitioner or an internist rather than a neurologist or an ear, nose, and throat (ENT) specialist (Neuhauser et al, ). Stroke is the underlying etiology in 17%–25%, and 4% of patients presenting with acute onset isolated vertigo (Norrving, Magnusson, & Holtas, ; Zuo et al, ) and dizziness (Navi et al, ), respectively. Of note, 18.9% of patients with vertebrobasilar stroke suffer from vertigo in comparison with only 1.7% of those with stroke in the anterior circulation (Tao et al, ).…”

Section: Introductionmentioning

confidence: 99%

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Relation of infarction location and volume to vertigo in vertebrobasilar stroke

et al. 2020

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Objective Vertigo is a common presentation of vertebrobasilar stroke. Anecdotal reports have shown that vertigo occurs more often in multiple than in single brainstem or cerebellar infarctions. We examined the relation between the location and volume of infarction and vertigo in patients with vertebrobasilar stroke. Methods Consecutive patients with vertebrobasilar stroke were prospectively recruited. The infarction location and volume were assessed in the diffusion‐weighted magnetic resonance imaging. Results Fifty‐nine patients were included, 32 (54.2%) with vertigo and 27 (45.8%) without vertigo. The infarction volume did not correlate with National Institute of Health Stroke Scale (NIHSS) score on admission (Spearman ρ = .077, p = .56) but correlated with modified Rankin Scale (ρ = .37, p = .004) on discharge. In the vertigo group, the proportion of men was lower (53.1% vs. 77.8%, p = .049), fewer patients had focal neurological deficits (65.6% vs. 96.3%, p = .004), patients tended to present later (median [IQR] was 7.5 [4–46] vs. 4 [2–12] hours, p = .052), numerically fewer patients received intravenous thrombolysis (15.6% vs. 37%, p = .06), and the total infarction volume was larger (5.6 vs. 0.42 cm3, p = .008) than in nonvertigo group. In multivariate logistic regression, infarction location either in the cerebellum or in the dorsal brainstem (odds ratio [OR] 16.97, 95% CI 3.1–92.95, p = .001) and a total infarction volume of >0.48 cm3 (OR 4.4, 95% CI 1.05–18.58, p = .043) were related to vertigo. In another multivariate logistic regression, after adjusting for age, sex, intravenous thrombolysis, serum level of white blood cells, and atrial fibrillation, vertigo independently predicted a total infarction volume of >0.48 cm3 (OR 5.75, 95% CI 1.43–23.08, p = .01). Conclusion Infarction location in the cerebellum and/or dorsal brainstem is an independent predictor of vertigo. Furthermore, larger infarction volume in these structures is associated with vertigo. A considerable proportion of patients with vascular vertigo present without focal neurological deficits posing a diagnostic challenge. National Institute of Health Stroke Scale is not sensitive for vertebrobasilar stroke.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Relation of infarction location and volume to vertigo in vertebrobasilar stroke

et al. 2020

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“…Many studies have reported elevated serum NSE concentrations in a variety of conditions associated with CNS damage, such as stroke, traumatic brain injury, Alzheimer's disease, and multiple sclerosis (43)(44)(45)(46). Similar to our findings, increased serum NSE has been also reported to be the strongest indicator of acute cerebral infarct in patients presenting to the ER with acute isolated vertigo or dizziness (47).…”

Section: Discussionsupporting

confidence: 89%

Diagnostic Value of Serum Biomarkers for Differentiating Central and Peripheral Causes of Acute Vertigo

et al. 2020

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Background: In patients presenting with acute vertigo or dizziness, distinguishing central from peripheral is a diagnostic challenge. This study investigated potential serum markers for differentiating central and peripheral vertigo in patients with acute-onset vertigo. Methods: This prospective case-control study recruited consecutive participants from the Emergency Department, including patients with acute-onset vertigo or dizziness within 12 h and control subjects. We used enzyme-linked immunosorbent assays to measure the serum S100β, NSE, BDNF, GFAP, and IL-6 levels during the acute period. Results: The 114 study subjects included 28 patients with central vertigo (CV), 49 patients with peripheral vertigo (PV), and 37 age-and sex-matched healthy controls. No differences were found in risk factor distribution among the three groups. In patients with CV, the serum NSE and S100β levels were significantly (p < 0.05) elevated compared with the control and PV groups. The ROC analysis gave an AUC of 0.843 (95% CI = 0.753-0.932) for NSE and 0.787 (95% CI = 0.687-0.886) for S100β for predicting CV. However, there were no significant differences in the serum GFAP and BDNF levels among the CV, PV, and control groups. Conclusions: Serum NSE and S100β levels are significantly higher in patients with CV, such as occurs with posterior circulation ischemic stroke or vertebrobasilar insufficiency. S100β and NSE may serve as serum biomarkers for differentiating between CV and PV in patients with acute-onset vertigo.

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“…NSE is an isoform of glycolytic enzyme, which expression changes in acute phase of ischemic stroke [77]. In this process, the NSE serum levels are higher, compared to the hemorrhagic stroke and positive correlation has been reported between the ischemic infarct area and the NSE serum levels in acute phase of stroke.…”

Section: Neuron-specific Enolasementioning

confidence: 99%

Neurovascular Unit as a Source of Ischemic Stroke Biomarkers—Limitations of Experimental Studies and Perspectives for Clinical Application

Steliga

Kowiański

Czuba

et al. 2019

Transl. Stroke Res.

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Cerebral stroke, which is one of the most frequent causes of mortality and leading cause of disability in developed countries, often leads to devastating and irreversible brain damage. Neurological and neuroradiological diagnosis of stroke, especially in its acute phase, is frequently uncertain or inconclusive. This results in difficulties in identification of patients with poor prognosis or being at high risk for complications. It also makes difficult identification of these stroke patients who could benefit from more aggressive therapies. In contrary to the cardiovascular disease, no single biomarker is available for the ischemic stroke, addressing the abovementioned issues. This justifies the need for identifying of effective diagnostic measures characterized by high specificity and sensitivity. One of the promising avenues in this area is studies on the panels of biomarkers characteristic for processes which occur in different types and phases of ischemic stroke and represent all morphological constituents of the brains' neurovascular unit (NVU). In this review, we present the current state of knowledge concerning already-used or potentially applicable biomarkers of the ischemic stroke. We also discuss the perspectives for identification of biomarkers representative for different types and phases of the ischemic stroke, as well as for different constituents of NVU, which concentration levels correlate with extent of brain damage and patients' neurological status. Finally, a critical analysis of perspectives on further improvement of the ischemic stroke diagnosis is presented.

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Clinical and laboratory factors related to acute isolated vertigo or dizziness and cerebral infarction

Cited by 17 publications

References 28 publications

Relation of infarction location and volume to vertigo in vertebrobasilar stroke

Relation of infarction location and volume to vertigo in vertebrobasilar stroke

Diagnostic Value of Serum Biomarkers for Differentiating Central and Peripheral Causes of Acute Vertigo

Neurovascular Unit as a Source of Ischemic Stroke Biomarkers—Limitations of Experimental Studies and Perspectives for Clinical Application

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